Archive for the ‘Diet and Weight’ Category

Diet soft drinks have been around for decades. You would expect them to help people lose weight. But the world’s obesity epidemic is just getting worse. There are many factors that lead to weight gain, but could the consumption of diet drinks, which have far less calories than sugary beverages, actually be a negative factor?

Researchers from Johns Hopkins University reviewed the eating and drinking habits of 24,000 adults…

I was performing minor surgery on a pretty young lady’s upper arm recently. As always, I warned her about her chances of having a scar from the procedure and offered to send her to a dermatologist who could probably make a prettier scar than I could.

She said without pausing to think about it,” Oh, don’t worry, I never wear short sleeves anyway. I hate my arms.”

I said “Ok,” and finished the procedure. I told her how to care for the wound and when to come back to have the stitches removed. We parted ways and I went on to my next patient. That brief conversation really stuck with me though. I thought about it the rest of the day.

She is a pretty, healthy, 31-year-old mother and wife that has gotten so used to being overweight that she never shows her arms and never plans to. That just kills me to hear, giving up on health at 31. Throwing in the towel and surrendering to a weight which will ultimately rob her of health and seems to have already taken her self-respect — it’s a terrible thing.

I wish I knew how to give her some hope again. I certainly want to help those who haven’t lost all hope push ahead and reclaim their health.

As a society, we are consuming factory-made food and drink, getting way too big by doing it, then running to chemicals (yes, hCG and other homeopathy or ‘all-natural’ products are chemicals) for a quick fix. Look how well it’s working!

What I see every day are heavy, unhealthy, unhappy people desperate for an antidote. What I see less often is a heavy, unhealthy, unhappy person desperate enough for a change. Guess who ends up better off?

I tell patients over and over, day after day: “There is no quick fix. There is no magic pill. If anything really worked, would anybody still be fat?”

Overweight is about calories, folks. There is no way to dodge this issue. The FDA link above has a short, blunt video exposing the hCG diet plans for what they are.

Yes, people lose weight on them. No, hCG has nothing to do with it. Then why do they work?

500 calories a day!! That’s the diet plan they recommend! No surprise, when you eat like you live in a concentration camp, you lose weight. The problem is, cutting your calories to this point can cause serious problems with your body including passing out or having an irregular heart beat. Definitely not try-it-at-home stuff here.

Rather than looking for the quick easy fix that doesn’t exist, change is needed. Changing our food and drink to match what our bodies need for health is the only way to be healthy. My motto is absolutely true: Eat Healthfully, Live Fully Healthy!

I just saw Lois yesterday. I have to admit, I was surprised to find her smiling when I walked in the room – coming to see me doesn’t usually put a smile on her face.

The fact the scale showed 40 pounds off in the last 4 months may have something to do with her smile. Her diabetes had really gotten out of control, needing over 150 units of insulin a day to keep her sugars from being sky-high.

Now? She’s cut her own dose back to 30 units and I told her to cut it back even more. I think she’ll be able to stop the insulin altogether soon!

When I started her on the insulin shots a couple of years ago I promised her she could fix this and come off it if she changed her habits. I can’t say I really had much hope she would, but wow has she proved me wrong.

She finally joined Weight Watchers (the only diet program I ever recommend since it’s the only one that is a forever life change and not just a quick fix.) Her daughter is doing it with her and has lost even more weight, probably preventing diabetes completely for herself.

It turns out that reading and re-reading my book is what spurred her to make the change.

She said, “When I read that thing it’s just like you’re sitting there beside me, telling me how it needs to be, nagging me to do better!”

“Perfect!” was my response. That is exactly what I want my book to be, an extra-long, face-to-face conversation with me about food choices and health.

For Lois, it looks like that “long conversation” is working – way to go!!

I recently read a debate between a Ph.D. nutritionist and a physician about whether a person can be fit and fat. This is an old argument that has lots of heat and emotion involved and not much logic or reason. These experts argue about whether an overweight athlete is healthy but never really agree on how athletic or active this imaginary person is or even what they mean by healthy.

In the end both agreed that being normal weight was a good idea and exercise is good for you. Amazing! The MD said what I’ve always said: show me this person and we’ll talk. After 15 years of examining thousands of patients a year, I don’t think I’ve met anyone in this category.

The drink has a chemical called alginate that is liquid in a drink but changes to a gel once it hits stomach acid. Interesting idea though it doesn’t sound that safe, really. Intestines blocked with gel-sludge could keep surgeons way too busy.

Seriously, this may have a future, since much of the trouble with eating less is the hunger people dread. The recommendation I give is to eat apples and drink water to relieve the hunger pangs. The pectin in apples actually does this same thing, thickening in the stomach and providing a full feeling. My guess is the drink will cost a bit more than an apple.

Rejected Diet Pill

The diet pill Qnexa was getting some positive attention after news of the 10% weight loss people had in experiments. Now it’s getting more attention but of the bad kind. There were people with psychological problems and heart problems while taking the experimental drug. Not many doctors would be surprised by the news since those are the problems the ingredients can cause too!

There is an enormous market and demand for weight-loss drugs, which means the drug companies will keep working at it. The company that owns Qnexa says they will keep trying to convince the government of the drug’s safety. My hope is that the FDA will do their job and protect patients. Combining the ingredient in Adipex with a seizure drug and hoping its safe sounds like wishful thinking to me.

I’ve written elsewhere that I don’t prescribe Adipex. I get at least one request a week from someone desperate for some kind of help. I try to refuse gently and reasonably, but I still see the frustration and disappointment.

“Adipex isn’t safe,” I say. “It isn’t safe, it doesn’t work and I have to carry extra malpractice insurance just to prescribe it.”

“Really?”

That’s the best answer I could hope for — it means someone just listened! There is very little proof of phentermine (Adipex) working in the short-term and none at all that it works over the long-haul. If it works, most people lose 10-15 pounds over 3-6 months.

Once it is stopped, my experience is that everyone goes right back to their old eating habits and gains all that weight right back. Nothing really changed. If a person won’t change their attitude and approach to food, if they keep eating like an American, they should expect every fad diet and diet pill to fail, Adipex too.

The safety part of phentermine is my biggest problem with it. That whole “Do no harm” vow sure can slow a doctor down. There may not be much proof that it works but I think there’s plenty of proof that phentermine can cause mental problems and permanent heart damage. That’s why my first insurance company after graduation required me to pay for a policy rider if I prescribed medicine for diet and weight loss. They were so sure I would be sued for prescribing these medicines they wanted me to pay more ahead of time!

That’s actually when I started looking in-depth at these drugs and came to my decision not to prescribe them. The drugs in this family work by the same effect on the brain and all have the same risks to the brain and the heart. Two of the drugs have already been taken off the market: Fen-phen and Meridia. I think that phentermine should have been withdrawn too, but it is so old the FDA rules that apply to it are a little hazy about safety so it has stayed around.

Public Citizen wants them Banned

This ABC News article is about the other weight-loss drug type available, the fat-blockers Xenical and Alli. There have been complaints about both drugs in the public since they came out. Like the other diet pills, these don’t really work and don’t change the person, plus they offer the nifty side effect of “flatus with discharge” according to my epocrates app. For those not in the know, this is also called “oily anal discharge” or “anal incontinence.” However politely you say it, this is pretty gross.

The Public Citizen complaint to the FDA says they cause worse problems too, like pre-cancer in the colon and vitamin deficiency. Again, plenty of bad effects, underwhelming weight loss (10-15 pounds for all of them) and no permanent change in weight or health. Not a very good deal, especially when you consider how much these pills cost and that insurance won’t pay for them.

There is one other diet pill on the near horizon. Contrave is still working its way through the FDA, with a solid “Yes, maybe” from them in December 2010. Whatever they decide about this medicine (other than high blood pressure and seizures it seems pretty ‘safe’) it’s still good for only about 10 pounds. The company can sell it to us with a straight face, saying “If you take it for a year, you’ll probably lose 10 pounds.” Seriously?

Expensive, bad side effects, crummy results — how about learning some new habits and finding joy in feeling well and eating healthy? Come on, try it, you’ll like it!

I want to get into food in a way I’ve never seen another author do it. I want to help teach people to know their food. I want choosing the right foods to be as natural as choosing the right outfit. If I had my way, this teaching would be done and learned by the time a kid was about a third grader. Everyone would know their food like they know their alphabet and multiplication tables.

Nutrition education, deeply known and acted on, would solve many of our problems with weight (and maybe bankrupt McDonald’s and a few other deserving companies along the way.)

Unfortunately, if you’re old enough to drive to the bookstore and browse this introduction, you’re probably past the point where it’s easy to learn new habits – what we often call “adulthood.” Now, don’t get me wrong. There are lots of good things about being an adult besides having a driver’s license and a credit card, and adults are absolutely capable of learning new habits.

It’s just not easy. It’s not. Simply put, adults learn facts much more easily than children but learn behaviors much less easily than when they were children. That makes a book like this so important. The facts need to be learn-able and the reasons to learn them plain and the motivation to change obvious.
I’ve talked to thousands of folks that want to lose weight and learned some things from them and about them along the way.

First, change only happens when someone wants to change. Whether it’s quitting cigarettes or Burger King or excess TV, “it’s a free country” as I remind my patients and myself every day. I have never and will never make someone lose weight and probably can’t even make them want to lose weight. The best I can do is coax, teach, encourage, inform, and support.

That’s the best this book can do too. If there is no “want to” in you right now, please look elsewhere for it. These pages will not make you do anything. What I hope I can do for you and with you is to open your eyes to habits, wrong information, and bad thinking about our bodies and the food we need to keep them in good working order….

I’m having a recurring theme come up in my conversations this week. Plenty of folks had lost weight last summer, maybe to quiet their nagging doctor? I’m starting to see them back for routine or urgent problems and I often notice the scale creeping back up.

I try to help people find the line between shrugging it off and beating themselves up over it, but that can be hard. What I want people to know are just a couple of simple things. I think these 3 thoughts should be kept in mind by anyone trying to change their diet or lose weight.

1) Realize the time it takes. We live in the fastest paced culture around. Drive-thrus, microwaves and the MinuteClinic make patience and perspective hard to remember. What I continually remind my patients is that the weight didn’t come on overnight so it can’t come off overnight either. Whenever you read an ad for a quick solution to health or weight, RUN! They’re either flat-out lying to you or peddling something harmful. Nature doesn’t do anything rapidly and trying to force your body into rapid weight loss will backfire, I promise.

Instead, be patient with yourself and your body. The little choices every day add up, so keep making good little choices and you’ll be amazed where you can end up!

2) Water first. I go over this topic in detail in Food Truths, Food Lies, but in a nutshell: Your body can’t tell thirst from hunger. So what does this mean? Drink water before eating anything, ever. A cold glass of water and 5 minutes may completely fix any craving you’re having. Even if it doesn’t, the water will help decrease the amount of food it takes to be satisfied. Drink up!

3) Think before you eat. This ties right into #2. Eating without thinking is probably America’s biggest “bigness” problem. Snacks and convenience foods are way too convenient. A recent study showed we eat an average of over 550 calories per day more than Americans did 40 years ago. Do the math: this is plenty to explain our weight problem. Think before it goes into your mouth and pare back those needless calories that won’t even be enjoyed. After all, how can it taste good if I eat without even realizing it?

Most of all, be kind and patient with yourself while making health changes. All you have to do is make healthy choices today. Keep it up and it will become a habit. Keep healthy habits and your body will thank you for it. I promise!

One was almost angry, the other almost completely resigned. Two still-young women in my office in back-to-back appointments recently, both with one thought on their mind: “That scale can’t be right!”

Both are busy moms with teens at home, days filled with errands, work, worry and everyone’s needs but theirs. These ladies are why I (usually) love being a family doctor and get excited about helping people. These ladies are why I (sometimes) loathe being a family doctor and feel exhausted at the end of the day. See, frustration all around.

Both Sara and Tara (not their real names) are here to see me about their weight. These women aren’t asking me for a way to lose ten pounds either. Both are about 100 pounds away from being healthy and they know it… and they hate it.

Sara really just wants Adipex. Tara tried reading Food Truths, Food Lies but got discouraged by the challenge and quit. Sara tried an app to count calories and is sure she doesn’t eat more than 1,500 a day but still gains weight. Tara struggles with her normal-sized husband bringing home chips, cookies and other bad snacks even when she asks him not to.

See? Frustration. How do I help them? I’m not sure.

Sara hasn’t read my book yet, hasn’t yet found out all the ways her food habits are making her feel sick and gain weight. I don’t prescribe Adipex (ever!) for a whole bunch of reasons but I did agree to check her thyroid along with some other hormone and vitamin levels. I asked her to read my book — she really has a lot to learn about diet and nutrition. I’ll see her again in a few weeks, we’ll go over her lab tests and I’ll start trying to help her change 30+ years of eating habits that are making her sick.

Tara is easier to talk to but harder to help. I’m afraid she has given up on herself and is just calmly waiting for me to tell her she’s got diabetes, bad cholesterol, or whatever else will eventually go wrong. Which brings me to the real source of our frustration. I can’t make anybody want to change. I just can’t.

The good news is that Sara can absolutely lose weight and take control of her health without ever taking Adipex. Tara can absolutely find new hope and energy in little changes like eating a high-protein breakfast and skipping the orange juice and soda pop. All of us can always change, improve, and renovate our health with two little words: “I will.”

I’ve got pills for everything, it seems. I just wish I didn’t have to use them! So when I get a great success story like I had recently, I want to share it.

Gary came in several months ago because the nurse at work had found a very high blood pressure reading. I looked him over and did a few tests on his heart and immediately started him on the blood pressure medicine I thought would work best for him.

When I start a new medicine like this for a long-term problem, I always make sure to tell my patient if I think they have any way of fixing the issue and stopping the medicine. In Gary’s case, I thought it was pretty clear that he had neglected his health and was starting to have consequences from that. The good news, I told him, was that he could turn back the clock and fix his blood pressure and other health issues.

Since we had just met, I wasn’t sure how seriously he was taking his health or whether he really meant it when he said “I’ll fix this.” As I got to know Gary over the next few months and see his blood pressure come down to the safe range, I found out that he had truly taken my challenge. Just yesterday, we both realized that he beat it – we stopped one of his blood pressure medicines and made plans to come off everything in a few more months!

“I’m eating healthy and walking at least once a day,” he says. “Nothing fancy, just stuff I knew I should have done but never did until now. And I feel great!”

He ought to feel proud too. In five months, he’s lost over 30 pounds. The diet and exercise he’s done, while nothing crazy or difficult, has been made up of good choices day after day. Gary’s good choices have made his heart stronger, his sugar normal, and cut his cholesterol by almost 40%. All this in 5 months, while still enjoying life and working full-time. And the best part? Now I know Gary well enough to recognize that glint in his eye when he told me, “This is permanent.” I have no doubt.

“Most people take 30 minutes of fast, sweaty walking to burn off one can of Coke…. Want to burn off a pound worth of calories? Better pack a lunch (which just puts you further behind) because that will take 10 hours on the treadmill!”

The moral of this story? Think about it before it gets swallowed. Once it’s down the hatch, it can take a very long time to get burned off again.